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The Affordable Care Act, House Speaker John Boehner aside, is going to go into effect. The rules are being written, and in about half the states work has already begun to set up their side of the program. But there are obstacles beyond just Republican governors dragging their heels.

Here's one of the bigger challenges: how to bring in the millions of people who are completely unaware of the options they will have under the new law.

Part of the problem, experts say, is that people who will be affected don’t realize the urgency because the subsidies won’t begin for another year. But policy decisions are being made now that will affect tens of millions of Americans, and the lack of public awareness could jeopardize a system that depends on having many people involved. Low enrollment could lead to higher premiums, health policy experts say. Hospitals worry that, without widespread participation, they will continue getting stuck with patients’ unpaid medical bills. And advocates say the major purpose of the Affordable Care Act – extending health insurance to more Americans – will go unmet if large numbers of vulnerable people don’t take advantage of it. [...]

Seventy-eight percent of the uninsured Americans who are likely to qualify for subsidies were unfamiliar with the new coverage options in a survey by Democratic polling firm Lake Research Partners. That survey, sponsored by the nonprofit Enroll America, also found that 83 percent of those likely to qualify for the expansion of Medicaid, which is expected to cover 12 million Americans, were unaware of the option.

In separate October polling data from the Kaiser Family Foundation, 41 percent of voters described themselves as “confused” about the health-care law.

Sabotage has been a big part of the Republican fight to make sure that the Affordable Care Act doesn't succeed, their fallback position to doomed repeal efforts. Keeping the public uncertain about the fate of the law and confused on the aspects of the law is definitely part of that effort.

So is Boehner's promise of never-ending "investigations" by the House into the implementation of the law. House Republicans have already started in, specifically targeting the Department of Health and Human Services efforts to publicize the new law.

A number of non-profit organizations have formed a coalition under the umbrella Enroll America, "whose mission is to ensure that all Americans are enrolled in and retain health coverage." It's planning an advertising campaign to inform the public of options under the new law, but confusion in the states where Republican governors are gumming up the works will complicate that effort as well.

The Affordable Care Act will move forward. Now the fight is going to be making it a success.

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